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Compact, evidence-based guidance by a leading expert on how to undertake culturally sensitive psychotherapy and cross cultural engagement in any profession. This compact and authoritative book is designed to be useful to a broad range of professionals in their daily practice and to provide a basis for practice-oriented continuing education.

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Advances in Psychotherapy – Evidence-Based Practice, Volume 53

Developing Anti-Racist Cultural Competence

Rehman Abdulrehman

Clinic Psychology Manitoba, Private Practice, Winnipeg, MB, Canada

Lead With Diversity, Diversity Consulting Firm, Winnipeg, MB, Canada

Department of Clinical Health Psychology, Max Rady College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

About the Author

Rehman Abdulrehman, PhD, is a Canadian Muslim of Zanzibari descent who works as a clinical and consulting psychologist. His work has spanned continents and cultures, with a focus on the intersection of mental health; diversity, equity, and inclusion; and leadership. Among the clients that Dr. Abdulrehman has supported to address diversity, equity, and inclusion are Google/YouTube, Mastercard Foundation, the Canadian Broadcasting Corporation, and the Government of Canada. He has developed and hosted a podcast, Different People, addressing difficult conversations on racism, and developed the Bias Outside the Box tool, which went viral, to help people begin a conversation with themselves about the biases they hold. Dr. Abdulrehman was also a TEDx speaker with his talk “Resolving Unconscious Bias,” and his work has been recognized by the Society of Consulting Psychology for Excellence in Diversity & Inclusion Consulting. He is also an assistant professor with the Department of Clinical Health Psychology at the University of Manitoba and has held three visiting professor positions at Zanzibar University, the State University of Zanzibar, and Muhimbili University of Health and Allied Sciences, due to his development work in Tanzania. He was also the Chair of the Committee on International Relations in Psychology for the American Psychological Association (2015–2016). Dr. Abdulrehman’s work has been recognized by the Society of Consulting Psychology for Excellence in Diversity and Inclusion (D&I) Consulting (2022).

Advances in Psychotherapy – Evidence-Based Practice

Series Editor

Danny Wedding, PhD, MPH, Professor Emeritus, University of Missouri–Saint Louis, MO

Associate Editors

Jonathan S. Comer, PhD, Professor of Psychology and Psychiatry, Director of Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami, FL

J. Kim Penberthy, PhD, ABPP, Professor of Psychiatry & Neurobehavioral Sciences, University of Virginia, Charlottesville, VA

Kenneth E. Freedland, PhD, Professor of Psychiatry and Psychology, Washington University School of Medicine, St. Louis, MO

Linda C. Sobell, PhD, ABPP, Professor, Center for Psychological Studies, Nova Southeastern University, Ft. Lauderdale, FL

The basic objective of this series is to provide therapists with practical, evidence-based treatment guidance for the most common disorders seen in clinical practice – and to do so in a reader-friendly manner. Each book in the series is both a compact “how-to” reference on a particular disorder for use by professional clinicians in their daily work and an ideal educational resource for students as well as for practice-oriented continuing education.

The most important feature of the books is that they are practical and easy to use: All are structured similarly and all provide a compact and easy-to-follow guide to all aspects that are relevant in real-life practice. Tables, boxed clinical “pearls,” marginal notes, and summary boxes assist orientation, while checklists provide tools for use in daily practice.

Continuing Education Credits

Psychologists and other healthcare providers may earn five continuing education credits for reading the books in the Advances in Psychotherapy series and taking a multiple-choice exam. This continuing education program is a partnership of Hogrefe Publishing and the National Register of Health Service Psychologists. Details are available at https://www.hogrefe.com/us/cenatreg

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

Library of Congress of Congress Cataloging in Publication information for the print version of this book is available via the Library of Congress Marc Database under the Library of Congress Control Number 2024931598

Library and Archives Canada Cataloguing in Publication

Title: Developing anti-racist cultural competence / Rehman Abdulrehman, Clinic Psychology Manitoba,

Private Practice, Winnipeg, MB, Canada, Lead With Diversity, Diversity Consulting Firm,

Winnipeg, MB, Canada, Department of Clinical Health Psychology, Max Rady College of Medicine,

Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

Names: Abdulrehman, Rehman, author.

Series: Advances in psychotherapy--evidence-based practice ; v. 53.

Description: Series statement: Advances in psychotherapy--evidence-based practice ; volume 53 |

Includes bibliographical references.

Identifiers: Canadiana (print) 20240299183 | Canadiana (ebook) 20240299191 | ISBN 9780889375154

(softcover) | ISBN 9781616765156 (PDF) | ISBN 9781613345153 (EPUB)

Subjects: LCSH: Cultural competence—Handbooks, manuals, etc. | LCSH: Self-evaluation—Handbooks,

manuals, etc. | LCSH: Anti-racism—Handbooks, manuals, etc.

Classification: LCC HM793 .A23 2024 | DDC 303.48/2—dc23

© 2024 by Hogrefe Publishing

www.hogrefe.com

The authors and publisher have made every effort to ensure that the information contained in this text is in accord with the current state of scientific knowledge, recommendations, and practice at the time of publication. In spite of this diligence, errors cannot be completely excluded. Also, due to changing regulations and continuing research, information may become outdated at any point. The authors and publisher disclaim any responsibility for any consequences which may follow from the use of information presented in this book.

Registered trademarks are not noted specifically as such in this publication. The use of descriptive names, registered names, and trademarks does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

The cover image is an agency photo depicting models. Use of the photo on this publication does not imply any connection between the content of this publication and any person depicted in the cover image. Cover image: © Ian McCausland

Illustrations: Naomi Faber

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Dedication

Despite feeling like I was in touch with my cultural identity, I did not realize just how much of my cultural self I had locked up in the back of my mind until my son came into my life. When I observed the impact of a White-centered world on him, I saw a conflict in identity early in his life, and in realizing that, I also came to be aware of how much of my own cultural self I had imprisoned, simply to ensure a greater sense of safety for myself, and a comfort for those from the majority culture. In the realization of the experience of my son, my approach to cross-cultural competency shifted, requiring that my academic training and experience begin to line up with my personal lived experience, as it too had critical importance in the understanding of what it meant to be cross-culturally competent. Lived experience, as I was learning from my son, was so critical to our understanding of how to work better with people we perceive to be different. This book is dedicated to you, Yousuf, for opening my eyes. And to my parents, who endured the onslaught of systemic racism against their cultural identities, to ensure their children gained the privilege of finding a sense of safety they did not and do not have in a supposed “multicultural” society. To my brothers too, with whom I learned alongside, with whom I survived cultural erasure through humor and wit, and with whom I consistently debate and discuss what our cultural identity actually is. To my family, all of you, I dedicate this book, a symbol of our survival in a world where racism and discrimination of all forms tried to erase who we were as a people.

|vii|Acknowledgments

Sincere acknowledgments to the dedicated psychologists who already do this work on cross-cultural competence and anti-racism, including but not limited to Drs. Derald Wing Sue and Monnica Williams. Thanks to Dr. Sonya Faber for her assistance with helping to translate my model of cultural and ethnic identity development into a visual model.

Contents

Acknowledgments

Foreword

1  Description

1.1  Terminology

1.2  Overview

1.2.1.  What This Book Is Not

1.2.2  This Is Not a National Geographic Read

1.3  Culture and Intersectionality

1.4  What to Expect From This Book

2  Definition of Culture

2.1  Pluralism and Cultural Intersectionality

2.2  Cross-Cultural Models

2.3  Target Audience

2.4  Client Centered Models

2.5  How to Get to Know the Other Person Without Assuming

2.6  Solutions

2.7  Intersecting Identities and Intersecting Cultures and Your Client

2.8  Social Justice

2.8.1  What Social Justice Has to Do With Cross-Cultural Competence

2.8.2  Social Justice, Trust, and the Therapeutic Relationship

3  Bias

3.1  The Perspective of the Therapist

3.2  Bias Defined

3.3  Your Own Worldview and Bias

3.4  Definition of Racism

3.5  Ignorance and Bias

3.6  Bias in Canada and the US

3.7  Examples

3.7.1  Example One

3.7.2  Example Two

3.7.3  Example Three

3.7.4  Example Four

3.7.5  Example Five

3.7.6  Anxiety About Bias

3.7.7  What Happens When We Are Not Mindful of Bias

3.8  Solutions

3.9  More Examples

3.9.1  Comedians and Cultural Competence

4  The Perspective of the Client

4.1  Assimilation and Cultural Identity

4.2  Internalized Racism and Blaming Themselves or Their Own Cultures

4.2.1  Example

4.2.2  Example

4.3  Self-Critical Beliefs

4.4  Internalized Racism, Identity Hiding, and Code Switching

4.5  The Elephant in the Room

4.6  Supporting Human Rights While Remaining Anti-Racist

4.7  Multiple Contributors to Cultural Identity

4.8  The Challenge

4.9  Cultural Safety

4.10  Cultural Congruence

4.11  Vulnerability

4.12  Politicized Identities and Psychological Checkpoints

5  A Culturally Sensitive Working Relationship and Social Justice

5.1  Transference and Countertransference

5.2  The Good Immigrant

5.3  Intercultural–Intracultural Conflict and Power Imbalances

5.4  Policing Your Own People

5.5  Cultural Humility

5.6  Social Justice Through Decentering Whiteness

5.7  Social Justice Globally

5.8  Giving Up Power

6  Common Themes

6.1  Tips to Consider

6.1.1  Professionalism and Self-Disclosure

6.2  Collectivism Versus Individualism & Family Relationships

6.3  Religion

6.4  Gender and Female Empowerment

6.5  The Pressure to Assimilate

6.6  Summary

7  Beyond the Therapy Room

7.1  Friendship Circles and Getting the Inside Joke

7.2  Allyship / Co-Conspiratorship

7.3  Professional Roles and Boundaries

7.4  The White Savior

7.5  Jane Elliott

7.6  Getting Your Hands Dirty

7.7  Racism in Police Officers

7.8  Conclusion

8  Further Reading

9  References

10  Appendix: Tools and Resources

|xiii|Foreword

If working in the area of diversity training and research for 20 years has taught me something, it’s that teaching anyone anything about race, ethnicity, and culture is a hazardous minefield of hidden dangers. People tend to be very embedded in their own worldview and perspectives, and simply providing the facts is rarely enough to bring about a meaningful shift in thinking. The issue of race is perhaps one of the thorniest areas to navigate, as White people in Western cultures are socialized from birth to not see the advantages they gain from Whiteness. Likewise, people of color learn that pointing out racial inequities often engenders social punishment, and so they learn to keep quiet when not with trusted others. And when you assemble a group of people of different races, ethnicities, and cultures in one classroom, talking about these issues can be volatile. I have known many colleagues who endured classroom discussions that quickly devolved into chaos and became unmanageable – to the point where even the professor was left in tears (Faber & Williams, 2023). Teaching this material can be especially perilous for untenured faculty, as noted by Boatright-Horowitz and Soeung, whose 2009 paper on the matter is tellingly titled “Teaching White Privilege to White Students Can Mean Saying Good-bye to Positive Student Evaluations.”

Fortunately, my own courses on diversity usually go quite well – which I attribute in part to learning from my prior disastrous attempts (yes, attempts plural) at teaching multicultural psychology at the undergraduate level. Consistent work in this area has resulted in classrooms where my students are respectful of me and each other, and they genuinely appreciate their learning experience. Nonetheless, there are few good resources for teaching clinicians how to be culturally competent. In the process of teaching this subject at the graduate level, I eventually realized that I would need to produce the course materials myself if I was going to deliver the class in the way I wanted. This led to me writing two books, one on eliminating race-based mental health disparities across settings (M. T. Williams et al., 2019) and a second to teach clinicians about how to manage microaggressions in therapy (M. T. Williams, 2020). I was able to make good use of both of these resources until moving to Canada in the summer of 2019 from the United States. Although my Canadian students still appreciated the book on microaggressions, the one addressing mental health disparities did not translate as well into a new national health care context. And it wasn’t long before students were asking for materials that were Canadian grown, as anything from the US was too easy to dismiss as not relevant in a country that tends to view itself as a multicultural utopia.

This request was a symptom of an even more pernicious problem. Too many Canadians drank the multicolored Kool-Aid and adopted the belief that only the US has problems with racial prejudice. As such, the problem of |xiv|cultural incompetence may even be worse in Canada than the US, because many Canadians look with disdain at their neighbors to the south and believe that they do not need to learn anything more. But in reality, research shows that Canadians are every bit as racist as Americans (Gran-Ruaz et al., 2022). In my work for the Canadian government, I saw this first-hand when I led a team of psychologists that interviewed federal employees of color across six different agencies. Every person we spoke to had disturbing stories to share about racism, hate, and loss of opportunity (OAG, 2023; Williams et al., 2023). So as a result of biases and huge educational oversights, most people are inept at interacting across race, ethnicity, and culture. And I’ll go ahead and add religion to this list too, since religious traditions are largely shaped by culture.

But rest assured, in the US, training and education on how to navigate cultural differences is deficient as well. During my journey as a clinical psychology graduate student at the University of Virginia, there was a gaping hole in our educational treasure map – the absence of any formal course to help us learn to engage with clients from different ethnic groups. My department did not offer any diversity courses at all, and graduate students were shooed away from venturing into the school of education, the only place where a graduate course on multicultural issues might be lurking. Our clinical psychology faculty, in their infinite wisdom, believed they had all the knowledge necessary to mold us into superior clinicians and researchers. Yet you cannot pass on the wisdom you never had. These professors, who had never been schooled in the art of addressing diversity, were simply unable to equip us with the tools we needed to launch into this next crucial part of our careers. We were only trained to treat White Americans.

Fast forward to 2023. We are post–George Floyd, which sparked a global racial reckoning. Racism is real. People of color are suffering. Most of us are now waking up to the fact that we are clueless and only pretending to have multicultural skills where we actually have none. In my experience doing diversity training in the US, Canada, and internationally, I find that even seasoned, mature, and otherwise well-trained psychologists struggle to operate in a culturally informed manner. Thus far I have yet to give a talk where I did not have to spend the first half of my presentation giving definitions to common cultural terms so that we could all be having the same conversation.

This brings to me this excellent book written by eminent diversity psychologist, Dr. Rehman Abdulrehman, Developing Anti-Racist Cultural Competence, which I wish I had had as a resource years ago. Cultural competence in simple terms is the capacity to interact effectively, inclusively, and fairly with people from diverse cultural backgrounds. Although the definition seems straightforward, its execution and realization are intricate and challenging. Cultural competence must be understood as an aspirational goal. While we cannot ever reach it as a final destination, the journey is necessary, as it enables us to make progress toward having more effective, inclusive, and equitable interactions across differences.

In this context, we should consider cultural competence an ongoing voyage rather than a fixed endpoint. We are constantly evolving in our cultural |xv|competence instead of ever truly attaining it, because cultural competence is a dynamic, shifting, and constantly demanding lifelong endeavor. And as Dr. Abdulrehman points out in this book, over time, culture evolves, and when two different cultures come in contact, they both are changed. As such, we cannot simply decide to stop learning, which underscores the need for cultural humility. One of the things I most appreciate about this book is the emphasis on learning about our own biases to ultimately promote trust, openness, and understanding among the diverse people in our world. And the bonus is that as we learn about ourselves and how to interact with people who are different, we improve all our relationships. We become more kind, empathetic, and sensitive. We become better citizens of the world – the first step in healing the mental health of a society that sadly continues to inflict harm upon itself. As such, I plan to make this book required reading for all of my students.

As such, I am truly honored to have been asked to write the Foreword for this enlightening book on cultural competence. Even though I have written over 200 academic papers and now serve as the Canada Research Chair in Mental Health Disparities at the University of Ottawa, I never cease to be impressed by my esteemed and accomplished colleague. I have seen Dr. Abdulrehman on major media outlets with national leaders, cogently commenting on the most critical social issues facing Canada. He has also worked overseas to bring mental health care to developing nations, and he presented a compelling TEDx Talk about the struggle to teach his son his cultural values in the face of a Western society that does not always embrace different cultural perspectives.

Having witnessed firsthand the transformative power of embracing diversity and fostering an inclusive environment, I am proud to endorse this book. Dr. Abdulrehman’s dedication to promoting cultural competence and his insightful approach to addressing the challenges we face in this ever-evolving world make him and his work an invaluable asset. His book not only provides essential knowledge but also serves as a testament to his own commitment to advancing our collective understanding and promoting equity.

Monnica Williams, PhD, ABPP

Canada Research Chair in Mental Health Disparities

University of Ottawa, ON, Canada

References

Boatright-Horowitz, S. L., & Soeung, S. (2009). Teaching White privilege to White students can mean saying good-bye to positive student evaluations. American Psychologist, 64(6), 574–575.

Faber, N. & Williams, M. (2023). The intersection of race and femininity in the classroom. Frontiers in Psychology: Gender, Sex and Sexualities, 14, Article 1139320. Crossref

|xvi|Gran-Ruaz, S., Feliciano, J., Bartlett, A., & Williams, M. T. (2022). Implicit racial bias across ethnoracial groups in Canada and the United States and Black mental health. Canadian Psychology, 63(4), 608–622. Crossref

Office of the Auditor General (OAG). (2023). Inclusion in the workplace for racialized employees (Report 5) [Reports of the Auditor General of Canada to the Parliament of Canada]. https://www.oag-bvg.gc.ca/internet/English/parl_oag_202310_05_e_​44338.html

Williams, M. T. (2020). Managing microaggressions: Addressing everyday racism in therapeutic spaces. Oxford University Press.

Williams, M. T., Faber, S. C., Abdulrehman, R. Y., MacIntyre, M. M., Harrison, T., Gallo, J. & Dasgupta, A. (2023, March3). The experience of racism by public service employees. [Report commissioned by the Office of the Auditor General of Canada]. Government of Canada.

Williams, M. T., Rosen, D. C., & Kanter, J. W. (2019). Eliminating race-based mental health disparities: Promoting equity and culturally responsive care across settings. New Harbinger Books.

|1|1Description

1.1  Terminology

Dictionaries such as Oxford and Merriam-Webster often adopt words commonly used in everyday culture otherwise known as slang (e.g., pumpkin spice, yeet, Galentine’s day), offering them legitimacy. Specifically, words and phrases from marginalized cultures have also been incorporated into these dictionaries, as elements of some experiences can best be described only by those cultures and by the people from those cultures who have unique worldviews and experiences. Words like “side hustle” (from the Black American community, reflecting the need for additional jobs or economic endeavors to create economic equity not typically afforded to the community), “coconut” (a person of color who is brown on the outside but has given up their culture to be White on the inside), and whitewashing (first used by Wiley A. Hall in the Afro-American Star in 1997, to denote Hollywood’s removal of the perspective and presence of people of color in film; Helliger, 2022).

When the dominant culture does not acknowledge the presence, let alone represent the experience, of people of color and those from nondominant communities, it is difficult to rely on White people to explain the nuances of the experiences of these communities. This book will include both terms that are well known in professional circles, as well as terms and phrases developed by and used colloquially by communities of color, which reflect their cultural experiences as marginalized people in Western countries. Definitions and implications of these terminologies will be addressed as they are brought up in the book.

The words themselves reflect the challenges that many people of color face as cultural entities in the midst of a world and society where the standard set cultural expectation is White. And furthermore, the cultural challenges faced by many nonracialized or White passing people who come from Eastern cultures (e.g., some Arabs or Balkan Europeans) in a culturally dominant White world, where standards of culture are based in a Western White world rooted in colonialism. Each of these words or terminologies reflect the challenges faced by people of color in a White or Western world. Words like “coconut,” “banana,” or “Twinkie,” “Oreo” (and even the exaggerated “double stuffed Oreo”), and “apple,” reflect the ideology of lost cultural roots where someone can be one color on the outside, while inside they are culturally White. The terms “ABC” (American-born Chinese) or “ABCD” (American-born |2|confused Desi) speak to Asian people losing culture to adopt Western or White culture in lieu of their own or even a healthy integration of both. The slur “Uncle Tom” refers to Black people who are humiliatingly subservient to White people, and reflects the pressure some people of color may face to defend, stand up for, and manage White interests against their own community of people, out of fear of being marginalized themselves. The term “fresh off the boat” refers to people of color who are not acculturated into White cultural dominance, but also highlights the pressure to conform. As does the almost opposite term “model minority,” a phrase describing people of color who do as they are told by White culture, and who succeed by keeping their head down, not making waves, hoping to achieve the “American Dream.” All these terms reflect cultural challenges of people of color, that are not always centered in our engagement cross-culturally. Yet they highlight a significant conflict and the presence of racism in nondominant cultural groups, who are not White. And based on that conflict, I will also introduce a term of my own, “psychological checkpoint,” in Section 4.12, that discusses how in everyday society, it is not uncommon for people of color to have to pass through random psychological checkpoints, at the behest of White people, where they must confirm allegiance to political beliefs and ideologies, that advantage White people over people of color, in order for them to be granted access to services and everyday discourse and exchange of ideas.

I will address the topic of cross-cultural skills and development of those skills from a viewpoint that centers the perspectives and experiences of people of color in Chapter 6, and from an understanding of the terminology outlined above, throughout this book, but specifically in Chapters 4, 5, and 6. Furthermore, this book addresses these skills as something any professional must develop, rather than solely addressing health and mental health professionals, and I believe the responsibility for change lies in all professionals of all ethnicities and cultures.

Remember that learning about and being aware of these colloquial terms does not mean you can liberally use them yourself, particularly if you are not from the community they target. For example, if you are White and you call someone an ABCD, an Uncle Tom, or an Uncle Tom you will be very insulting. The same goes for terminology that is meant to be positive. So, for example, a White woman professional calling her Black woman client “girlfriend” can also be offensive because it can unintentionally create a mockery of cultural language and/or suggest an equality of privilege that does not exist. This may change with friendship and familiarity, in the same way that a romantic partner can call someone “sweetie pie” but a colleague cannot. Being aware of colloquial terms allows you to be aware of the experiences of people of color, but does not allow you to use them casually. But more descriptive terminology that describes an experience, such as model minority or psychological checkpoint, can and should be more broadly used to describe experiences of people of color when working with them professionally to better describe their experiences. Keep in mind that the client may not be aware of such professional terminology, so it is still better to describe the experience and query about it, before labelling it.

|3|1.2  Overview

1.2.1.  What This Book Is Not